ASPO Abstracts
Evaluation of provider tools for referral to cancer genetic counseling and testing for breast and ovarian cancer risk
Category: Early Detection & Risk Prediction
Conference Year: 2019
Abstract Body:
PurposeThe goal of this study was to assess the referral patterns of family history screeningtools forfor breast and ovarian cancer risk.MethodsWe selected seven tools used to help providers screen patients for referral to genetic services for cancer risk using family history of cancer for evaluation. These included the Breast Cancer Genetics Referral Screening Tool, Pedigree Assessment Tool, Family History Assessment Tool, Breast Cancer Screening Questionnaire, Six-Point Scale, the Family History Screener, and the Michigan Wheel. For each tool, we compared the percentage of women who would be referred to genetic counseling against referral to genetic services using BRCAPRO scores and referral criteria from the National Comprehensive Cancer Network. Personal history of cancer and cancer in first- and second-degree family members were input into each of the selected tools to identify the percentage referred. Concordance between tools was measured using Cohen’s Kappa. Analyses used self-reported data from the 2005 California Health Interview Survey (CHIS) and data from a CDC-funded study at the Henry Ford Health System. ResultsPercentage of patients indicated for referral varied widely between tools, ranging from less than 1% to as high as 24%. Percentage of patients referred was higher among the clinic sample than in the population-based sample. These disparate results were likely duedue to 1) differences in level of detail in ascertaining family history of cancer, and 2) difdifferences in tool characteristics. Results of the concordance analysis indicated slightto modmoderate agreement in referral patterns. Lower levers of concordance are likely due to varvariation among tools on level of detail in personal and family history required and numnumber of cancer types included. In addition, some tools had a significantly lower thrthreshold of personal and family history required for referral, or were less specific in ideidentifying individuals at high risk, thus leading to greater referrals. ConclusionsResults provide health systems, medical practices, and providers with information on the performance of screening tools for genetic counseling referral based on family history of cancer. Results also may inform decisions about infrastructure needs and capacity.
Keywords: family historyReferral tool